US5462060A - Methods and apparatus for determining when tachyarrythmia is pace-terminable - Google Patents

Methods and apparatus for determining when tachyarrythmia is pace-terminable Download PDF

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US5462060A
US5462060A US08/248,329 US24832994A US5462060A US 5462060 A US5462060 A US 5462060A US 24832994 A US24832994 A US 24832994A US 5462060 A US5462060 A US 5462060A
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chamber
determining
conduction
determined
intervals
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Peter Jacobson
Daniel Kroiss
Christine Henry
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Sorin CRM SAS
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Ela Medical SAS
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/3621—Heart stimulators for treating or preventing abnormally high heart rate
    • A61N1/3622—Heart stimulators for treating or preventing abnormally high heart rate comprising two or more electrodes co-operating with different heart regions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39—Heart defibrillators
    • A61N1/3925—Monitoring; Protecting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39—Heart defibrillators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/38—Applying electric currents by contact electrodes alternating or intermittent currents for producing shock effects
    • A61N1/39—Heart defibrillators
    • A61N1/3956—Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Definitions

  • This invention relates to medical devices which monitor the cardiac state of a patient by sensing-atrial and ventricular heartbeats, and which analyze these signals to determine if a tachyarrhythmia is present, and, when present, to determine if the tachyarrhythmia is of a type which might be reverted by antitachycardia pacing.
  • pacing refers to the delivery of a stimulation pulse to cardiac tissue
  • antiitachycardia pacing or ATP refers to the delivery of any of one or more stimulation pulses that are intended to revert a tachyarrhythmia, including ventricular and/or atrial pacing
  • tachyarrhythmia refers to a rapid abnormal cardiac rhythm, including ventricular fibrillation (VF), ventricular tachycardia (VT), sinus tachycardia (ST), and superventricular tachycardia (SVT); SVT includes atrial tachycardia, atrial flutter, and atrial fibrillation; a normal cardiac rhythm without tachyarrhythmia is called sinus rhythm (SR).
  • VF ventricular fibrillation
  • VT ventricular tachycardia
  • ST sinus tachycardia
  • SVT superventricular tachycardia
  • SVT includes atrial tachycardia, atrial flutter, and atrial fibrillation
  • the medical devices that are the subject of this invention sense atrial and ventricular cardiacsevents (or beats), and derive therefrom one or more of the following intervals: between ventricular beats (RR), between atrial beats (PP), from an atrial beat to a ventricular beat (PR), and from a ventricular beat to an atrial beat (RP). They alternatively or in addition count the number of atrial beats (events) (Na) or ventricular beats (events) (Nv) in a predetermined number of cardiac cycles.
  • the term beat is synonymous with cardiac events, depolarization, complexes, and a heartbeat.
  • Arzbaecher, Bump, Jenkins, et al. PACE, Vol. 7, pp. 541-547 (1984) recognized that sensing heartbeats in a single chamber to determine when to apply ATP in that chamber, may result in inappropriate pacing and subsequent acceleration or even initiation of a tachycardia.
  • the inventors have recognized that .the background art proposes a stability criterion for determination of pace-terminable ventricular tachyarrhythmias, where it detects pace-terminable VT when there is RR stability and PR instability.
  • This method has as its origin the expectation that in pace-terminable VT, most ventricular beats are caused by a preceding ventricular beat, conducted by a circular pathway with stable conduction time. However, when most ventricular beats are caused by atrial beats, conducted by an atrioventricular pathway with stable conduction time, then this is not pace-terminable VT.
  • the inventors also have realized that there are deficiencies in the background art, particularly in the calculation and application of the stability criterion.
  • the Lehmann U.S. Pat. No. 4,860,749 does not disclose which atrial beat or beats to take into account when calculating the PR interval.
  • Na>Nv more than one atrial beat can be detected per ventricular cycle. If more than one PR interval per cycle is taken into account in an averaging calculation of stability, this will make the PR interval appear unstable, even though atrioventricular conduction with fixed block and very stable PR interval may be in progress.
  • the aforementioned background art only applies the stability criterion when Na>Nv.
  • the RR interval decreases (the rate accelerates), but PR remains constant.
  • the stability criterion could be applied to classify this, correctly, as not VT.
  • the Lehmann U.S. Pat. No. 4,860,749 does not disclose how to calculate PR instability or RR stability.
  • the Schuger publication (with Lehmann) does suggest to use averages over several cardiac cycles. However, this technique is grossly affected by a single premature beat, a burst of electrical noise, or by a single heartbeat which is not sensed.
  • the inventors also have recognized that the stability criterion could be applied to detecting pace-terminable tachyarrhythmias in the atrium as well as the ventricle.
  • an object of the invention to improve the specificity for detection of pace-terminable tachyarrhythmias, particularly for tachyarrhythmias in an intermediate rate range. It is another object to improve the specificity by sensing atrial and ventricular heartbeats and processing the cardiac events detected over time with respect to the cardiac chamber suspected of originating the tachycardia.
  • the present invention provides improved specificity of pace-terminable tachyarrhythmia detection in a first chamber by providing a criterion requiring stability in that first chamber, and conduction instability from the second chamber.
  • the invention also pertains to determining when a tachyarrhythmia is pace-terminable in the atrium or in the ventricle.
  • the present invention concerns apparatus and methods for sensing atrial and ventricular cardiac activity, taking into account all sensed beats from the second chamber which could have been conducted to a sensed beat in the first chamber, in addition to the beat in the first chamber immediately preceding the beat in the first chamber, applying the criterion to all rhythms in the first chamber, including rhythms with 1:1 association, to declare that rhythms without stability in that chamber are not pace-terminable, and calculating stability in such a manner that a few premature beats, incidence of electrical noise, or unsensed heartbeats in either chamber do not grossly affect the calculation.
  • the foregoing analysis is applied to either or both chambers.
  • the present invention relates to medical devices which, when applied in the ventricle, first identify VF as occurring with a ventricular rate above some first preset rate, and SR as occurring with a ventricular rate below some second preset rate; and then attempt to classify the remaining rhythms with rates between these two rates.
  • the invention also applies to devices which attempt to distinguish VT from ST or SVT in some intermediate range of rates.
  • the invention also concerns devices which deliver therapy after analyzing the cardiac rhythm and those that do not. It also applies to implantable and/or external devices. And it applies to the analysis of rhythms before, during, and after therapy.
  • therapy includes ATP, cardioversion, and defibrillation which are known and provided in a conventional manner.
  • the limits, fractions, or values may be fixed or they may be programmable.
  • the apparatus and methods concern the creation and maintenance of a histogram of recent intervals in the first chamber, and a histogram of recent conduction intervals from the second chamber to the first chamber during the same cardiac cycle, sorted in bins according to their lengths, obtaining an auto-correlation total, and a cross-correlation total, i.e., the total number of counts of events recorded in the respective histograms.
  • the histograms are then used to evaluate the following criteria (1) auto-correlation peak, i.e., the maximum number of recent intervals in the first chamber which meet a preset stability criterion; and (2) Cross-correlation peak, i.e, the maximum number of conduction intervals from the second chamber which meet a preset conduction time (stability) criterion.
  • auto-correlation peak i.e., the maximum number of recent intervals in the first chamber which meet a preset stability criterion
  • Cross-correlation peak i.e, the maximum number of conduction intervals from the second chamber which meet a preset conduction time (stability) criterion.
  • stability in the first chamber is declared when the auto-correlation peak, divided by the auto-correlation total, exceeds a preset fraction
  • conduction stability is declared when the cross-correlation peak, divided by either the auto-correlation peak (in a first embodiment of the invention) or by the auto-correlation total (in a second embodiment), exceeds a preset fraction.
  • the first embodiment of the invention compares the relative stability of conduction between chambers and conduction from the same chamber.
  • the second variant compares the stability of each to preset limits.
  • the tachyarrhythmia When there is no stability in the first chamber, the tachyarrhythmia probably is not pace-terminable in the first chamber. Hence, the tachyarrhythmia is declared not pace-terminable in that chamber.
  • a declared 1:1 association ratio another criterion is then used, for example, the presence of rate acceleration originating with disassociation at the onset of acceleration, to determine if the tachyarrhythmia is pace-terminable.
  • the invention concludes that the tachyarrhythmia is not pace-terminable in the first chamber, since it originates in the second chamber.
  • the present invention provides apparatus and methods for analyzing cardiac activity by sensing atrial and ventricular signals corresponding to cardiac activity to determine if a tachyarrhythmia is pace-terminable, characterized by determining the auto-correlation peak, based on recent intervals between cardiac signals detected in a first chamber satisfying a stability criterion, and determining the cross-correlation peak, based on recent cardiac signals detected in the same first chamber that correspond to signals detected in a second chamber, and are detected within a predetermined conduction time limit.
  • the cross-correlation histogram may contain a plurality of intervals corresponding to a single beat in the first chamber, and although only one of those intervals can result from conduction, all of them are considered "conduction intervals.”
  • the auto-correlation peak is preferably determined by maintaining a histogram of recent intervals detected in the first chamber such that the intervals are sorted by lengths into different bins, maintaining a count of the total number of events in the auto-correlation histogram, and sweeping the histogram with a predetermined window of stability to determine the maximum number of counts in the window for all possible positions of the window in the histogram.
  • the cross-correlation peak is preferably determined by maintaining a histogram of recent conduction intervals of detected events in the second chamber being conducted to and detected in the first chamber, corresponding to the same events recorded in the auto-correlation histogram, such that the conduction intervals are sorted by lengths into different bins, maintaining a count of the total number of events in the cross-correlation histogram, and sweeping the cross-correlation histogram with a window of a predetermined conduction time limit to determine the maximum number of counts in the window for all possible positions of the window in the cross-correlation histogram.
  • the step of maintaining the so called histograms of recent intervals and conduction intervals preferably maintains a sliding histogram of a predetermined number of the most recent cycles, wherein a cycle is based on the occurrence of a sensed beat in the first chamber.
  • the number of predetermined cycles may be programmable, and preferably is selected to be approximately 16.
  • the recent intervals in the first chamber are sorted preferably in bins according to their length.
  • a given bin has a value that corresponds to or is the number of intervals sensed that have a length that falls within the range of time lengths associated with the bin.
  • the recent conduction intervals from the second chamber to the first chamber are sorted in bins according to their lengths.
  • the sliding windows used for examining the contents of the histograms are preferably a number of contiguous bins corresponding to an interval variation, which interval variation may be programmable and is preferably approximately 64 ms.
  • the width of such a bin is typically approximately 16 ms.
  • the auto-correlation histogram records intervals having a length of between 125 ms and 600 ms, and the cross-correlation histogram records conduction intervals of between 16 ms and 500 ms.
  • the foregoing analysis is preferably not undertaken for intervals of the first chamber that are longer than a predetermined limit corresponding to sinus rhythm activity, which may be programmable, and which is preferably a limit of approximately 600 ms.
  • a predetermined limit corresponding to sinus rhythm activity which may be programmable, and which is preferably a limit of approximately 600 ms.
  • fast rhythms i.e., cardiac cycles in the first chamber above the sinus rhythm
  • the histograms are reset, i.e., cleared of data, and the bin counts all returned to zero.
  • the histograms may not be used to analyze cardiac rhythms again until after the determined intervals and conduction intervals are recorded for a preset number of fast cardiac cycles.
  • This preset number of cardiac cycles may be programmable, and is preferably 8 (optionally one half of the number of fast cycles recorded in the histogram).
  • Another aspect of the present invention provides for sorting the cardiac rhythm as a function of the auto-correlation peak and auto-correlation total according to the following:
  • Another aspect of the present invention provides for sorting the cardiac rhythm as a function of the auto-correlation peak and the cross-correlation peak, characterized by:
  • Another aspect of the present invention provides for sorting the cardiac rhythm as a function of the relative values of the auto-correlation total and the cross-correlation peak, characterized by:
  • the tachyarrhythmia is susceptible to be terminated by a stimulation pulse in the first chamber when there is stability in the first chamber and conduction instability.
  • Another aspect of the invention concerns the step of further sorting the cardiac rhythm having a determined stability in the first chamber and a determined conduction stability, by determining if there is a 1:1 association ratio (conduction) when the cross-correlation peak divided by the total of cross-correlation exceeds a predetermined fraction.
  • Another aspect of the invention concerns the step of further sorting the cardiac rhythm having a determined stability in the first chamber by determining if there is a many:1 association ratio (conduction) when the total count of events in the second chamber divided by the total of auto-correlation events exceeds a predetermined fraction.
  • the aforementioned predetermined fractions may be programmable.
  • the process of sorting cardiac rhythm i.e., determining whether a tachyarrhythmia falls into a "fast" rate that can be terminated by ATP in the first chamber, occurs only when the intervals between events in the first chamber are between a minimum and maximum predetermined limits, which limits may be programmable and preferably are 375 ms (corresponding to ventricular fibrillation and 600 ms (corresponding to a sinus rhythm), respectively.
  • a minimum and maximum predetermined limits which limits may be programmable and preferably are 375 ms (corresponding to ventricular fibrillation and 600 ms (corresponding to a sinus rhythm), respectively.
  • some historical average of recent fast and slow RR intervals is used for this evaluation.
  • the cardiac rhythms are sorted further when there is a determined stability in the first chamber and a determined conduction stability, by identifying the occurrence of an acceleration of the frequency in the first chamber which is greater than a predetermined acceleration limit, identifying the occurrence of a dissociation of conduction between the two chambers during the detection of the acceleration, and determining that the tachyarrhythmia is susceptible to be terminated by a stimulation in the first chamber when there is both acceleration and dissociation.
  • the step of determining if the tachyarrhythmia is susceptible to be terminated determines terminability only when it is also determined that there is a determined 1:1 association ratio, and preferably applies ATP to a tachyarrhythmia determined to be susceptible to termination by stimulation. It should be understood that the acceleration criterion is applied only after a determined 1:1 association ratio.
  • a determined 1:1 association ratio may for purposes of this disclosure be other than a mathematic 1:1 ratio, as previously noted.
  • an illustration of an embodiment of the present invention is applied to determining when tachyarrhythmias are pace-terminable in the ventricle.
  • the invention can equally well be applied to determining when tachyarrhythmias are pace-terminable in the atrium.
  • a flowchart showing the decision path of a routine in accordance with the invention, with entry point 1, following the detection of an R-wave (i.e., a ventricular beat).
  • the routine determines if the RR interval length exceeds a preset "slow" limit (which may be programmable and is preferably approximately 600 ms), in which case the rhythm is probably a sinus rhythm SR. (A large interval corresponds to a slow cardiac rate). If yes, a slow cycle counter is incremented at 3.
  • a preset "slow" limit which may be programmable and is preferably approximately 600 ms
  • the slow cycle counter count is tested, and if the count reaches a preset number Y of consecutive slow cycles (where Y may be programmable and is preferably approximately 16 cycles), then each bin of the histograms is reset at step 6. This action is taken based on the information previously stored being no longer current.
  • the routine does not perform the time- and power-consuming steps of updating and analyzing the histograms, which it does perform as described below, when a tachyarrhythmia might be present. This reduces battery consumption which is an important advantage for an implantable antitachycardia device.
  • the slow cycle counter is reset at 4. Then, at step 7 the method updates an RR interval histogram and a PR interval histogram.
  • the bin corresponding to the RR interval just elapsed is incremented, the bin that was incremented Z fast cycles ago (where Z may be programmable and is preferably 16), if any, is decremented.
  • the PR interval histogram the bin corresponding to each of the PR intervals detected in the last RR cycle, one for each detected P-wave, is incremented, and any bins which were incremented Z fast cycles ago, are decremented.
  • the histograms store information for the Z most recent cycles where the ventricular rate was faster than the slow limit.
  • a count of the total number of RR intervals in the RR histogram is maintained, referred to as the RR total (or auto-correlation total), and a count of the total number of PR intervals in the PR histogram is maintained, referred to as the PR (or cross-correlation total).
  • RR total or auto-correlation total
  • PR or cross-correlation total
  • a PP interval histogram and RP interval histogram are used in a parallel manner.
  • the histogram for cardiac intervals also is referred to as the auto-correlation histogram
  • the histogram for the conduction intervals also is referred to as the cross-correlation histogram.
  • the routine determines the auto-correlation peak (also called the RR peak), and the cross-correlation peak (also called the PR peak).
  • Each peak is determined by scanning all the bins of the particular histogram with a window, whose width may be programmable and is preferably 64 ms.
  • the window is placed at one end of the histogram range and the number of events in the bins within the window are counted.
  • the window is then shifted through the histogram range, one bin at a time. Each time the window is moved by one bin, the total of the counts in all the bins in the window is calculated. The highest total count of all of the possible window positions is saved as the maximum or peak count. In this manner, the peak is the maximum total number of counts in any set of contiguous bins which fit inside the window.
  • an averaged RR interval is compared to a preset "slow” limit, which may be programmable and is preferably approximately 600 ms. If the average RR interval is longer than the "slow” limit, the routine declares an SR condition at step 10 and the routine returns to wait for the next cycle at point 24, for subsequent cardiac event processing beginning at point 1.
  • the averaged RR interval is compared to a preset "very fast" limit (which may be programmable and is preferably approximately 375 ms). If the average RR interval is shorter than the "very fast" limit, a VF condition is declared at step 12. Optionally, therapy to revert ventricular fibrillation is applied at step 21 in response to a declared condition VF at step 12.
  • very fast which may be programmable and is preferably approximately 375 ms.
  • the averaged RR interval is used at steps 9 and 11 to prevent isolated premature beats, unsensed beats, and bursts of electrical noise, from grossly affecting the decision. It is maintained separately from the histogram and may be an average of the last 16 determined intervals. In alternate embodiments, a moving average, low-pass filter, X out of Y detector, or other conventional filter could be used.
  • the RR peak is divided by RR total. If the quotient is less than a preset fraction F1 (which may be programmable and is preferably approximately 75%) then it is declared unlikely that there is conduction on a fixed pathway from one ventricular sensed event causing the next. Accordingly, the device declares an SVT condition at step 14.
  • F1 which may be programmable and is preferably approximately 75%
  • the PR peak is divided by the RR peak. If the quotient is less than a preset fraction F2 (which may be programmable and is preferably approximately 75%) then it is declared less likely that there is conduction from the atrium to the ventricle than from the ventricle to the ventricle. Accordingly, the device declares a VT condition at step 16.
  • F2 which may be programmable and is preferably approximately 75%
  • the PR peak is divided by RR total (not shown). The decision is then made based on absolute stability of the PR interval, rather than on the relative stability of the PR interval, as compared with the RR interval.
  • the PR peak is divided by PR total. If the quotient is less than a preset fraction F3 (which may be programmable and is preferably approximately 75%) then conduction from atrium to ventricle is many:1, and there is little risk of confusing this with conduction from ventricle to atrium. Accordingly, the device declares an SVT condition at step 14.
  • F3 which may be programmable and is preferably approximately 75%
  • the process must apply another criterion to determine the origin of the tachyarrhythmia.
  • the criterion applied is an acceleration criterion in which the ventricular rate acceleration is compared to a preset limit, which may be programmable, and is preferably approximately 25%. If the rate does not exceed the limit, then it is declared likely that this is sinus tachycardia, and accordingly the device declares an ST condition at step 19.
  • step 20 it is determined if there was atrioventricular disassociation at the onset of ventricular acceleration. If there was, then it is declared likely that the tachyarrhythmia had a ventricular origin, and the device declares a VT condition at step 16. If there was not, then the device declares an SVT condition at 14.
  • One method for determining association requires, for example, that the conduction intervals for the accelerated beat and its predecessor both fall within a predetermined range corresponding to physiological conduction, e.g., 30 ms to 300 ms for atrio-ventricular conduction.
  • the appropriate therapy at steps 21, 22, or 23 is delivered by the device. Thereafter, the routine returns to step 24 and waits for the next cycle, and then resumes analysis at entry point 1.
  • the routine can suspend declaring the type of rhythm present until a preset number of cycles have been used to update the histograms.
  • the preset number may be programmable, and is preferably approximately 8.
  • the system embodying the present invention includes a device capable of the creation and maintenance of the appropriate histograms in suitable data storage devices and a software program or solid state finite state machine for the automatic computation of the RR and PR intervals (recalling that alternately and additionally the intervals may be based on atrial events, e.g., PP intervals and RP intervals), and the processing of the intervals to make the tests and determinations regarding stability, conduction instability, association, and acceleration, and the storage of the various predetermined parameters, constants, and fractions.
  • a device capable of the creation and maintenance of the appropriate histograms in suitable data storage devices and a software program or solid state finite state machine for the automatic computation of the RR and PR intervals (recalling that alternately and additionally the intervals may be based on atrial events, e.g., PP intervals and RP intervals), and the processing of the intervals to make the tests and determinations regarding stability, conduction instability, association, and acceleration, and the storage of the various predetermined parameters, constant
  • such a device also includes the detection of atrial and ventricular beats and the measuring of these beats and the noted intervals are performed by conventional devices having atrial and ventricular sense amplifiers, signal conditioning circuits, analog-to-digital conversion circuits, and suitable memory and registers for time-based digital data processing and manipulation as are now common in cardiac pacemaker, defibrillator and cardioverter devices.
  • Representative electronic circuits for acquiring the cardiac signals and determining the PR and RR intervals (and PP and RP intervals) are those found in the series of dual chamber pacemakers available from Ela Medical, Montrouge, France, offered under the CHORUS trademark.
  • the present invention is preferably implemented in software instructions loadable or loaded in memory for operating a microprocessor to process acquired cardiac signals, and is specifically applied following acquisition of the cardiac electric signals by conventional sense amplifiers, more preferably after the acquired signals have been conditioned and converted to a digital form.

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US08/248,329 1993-05-28 1994-05-24 Methods and apparatus for determining when tachyarrythmia is pace-terminable Expired - Lifetime US5462060A (en)

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FR9306406A FR2705576B1 (fr) 1993-05-28 1993-05-28 Procédé d'analyse de l'activité cardiaque pour déterminer si une tachyarythmie est susceptible d'être interrompue par stimulation.

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Cited By (84)

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US5730141A (en) * 1996-06-07 1998-03-24 Pacesetter, Inc. Tachyarrhythmia detection method
US5776164A (en) * 1995-10-13 1998-07-07 Ela Medical S.A. Method and apparatus for defibrillation of the atrium
US5868793A (en) * 1996-10-25 1999-02-09 Ela Medical S.A. Methods and apparatus for improved tachycardia discrimination in an active medical device
WO1999015232A1 (fr) * 1997-09-19 1999-04-01 Intermedics Inc. Dispositif pour la classification et la therapie des types de tachyarythmie par detection sur deux chambres
US5891170A (en) * 1996-06-18 1999-04-06 Ela Medical, S.A. Method and apparatus for advanced tachyarrhythmia discrimination
US5891044A (en) * 1992-10-06 1999-04-06 Gw Scientific, Inc. Detection of abnormal and induction of normal heart rate variability
EP0919256A1 (fr) 1997-11-21 1999-06-02 Pacesetter, Inc. Procédé et appareil pour traiter une tachycardie basé sur la stabilité ventriculaire
US5941831A (en) * 1998-04-03 1999-08-24 Pacesetter, Inc. Method for diagnosing cardiac arrhythmias using interval irregularity
EP0985428A1 (fr) * 1998-08-12 2000-03-15 Pacesetter, Inc. Stimulateur cardiaque avec système de sécurité de synchronisation des ondes-R pendant la correction par contre-stimulation de fibrillation auriculaire
US6285907B1 (en) 1999-05-21 2001-09-04 Cardiac Pacemakers, Inc. System providing ventricular pacing and biventricular coordination
US6304778B1 (en) 1999-08-20 2001-10-16 Cardiac Pacemakers, Inc. Implantable defibrillators with programmable cross-chamber blanking
US6351669B1 (en) 1999-05-21 2002-02-26 Cardiac Pacemakers, Inc. Cardiac rhythm management system promoting atrial pacing
US20020082509A1 (en) * 2000-12-26 2002-06-27 Scott Vanderlinde Method and system for display of cardiac event intervals in a resynchronization pacemaker
US20020091415A1 (en) * 2000-05-13 2002-07-11 Lovett Eric G. Rate smoothing control
US6430438B1 (en) 1999-05-21 2002-08-06 Cardiac Pacemakers, Inc. Cardiac rhythm management system with atrial shock timing optimization
US20020169483A1 (en) * 2000-11-27 2002-11-14 Christine Henry Discrimination of atrial fibrillations for an active implantable medical device, in particular a defibrillator/cardiovertor
US6487442B1 (en) 2000-04-28 2002-11-26 Nicholas Wood Detection of abnormal and induction of normal heat rate variability
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FR2705576B1 (fr) 1995-07-07
DE69419822T2 (de) 2000-01-05
EP0626182B1 (fr) 1999-08-04
JPH07148129A (ja) 1995-06-13
ES2134911T3 (es) 1999-10-16
DE69419822D1 (de) 1999-09-09
FR2705576A1 (fr) 1994-12-02
EP0626182A1 (fr) 1994-11-30

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